Page 1 of 2 City of New York Board of Standards and Appeals BUILDING PERMIT RENEWAL (BZY) Application Form 40 Rector Street, 9th Floor New York, NY 10006-1705 Phone: (212) 788-8500 Fax: (212) 788-8769 www.nyc.gov/bsa BSA APPLICATION NO._______________________ Section A Applicant/ Owner _______________________________________________ _______________________________________________________ NAME OF APPLICANT OWNER OF RECORD _______________________________________________ _______________________________________________________ ADDRESS ADDRESS _______________________________________________ _______________________________________________________ CITY STATE ZIP CITY STATE ZIP _______________________________________________ _______________________________________________________ AREA CODE TELEPHONE LESSEE / CONTRACT VENDEE _______________________________________________ _______________________________________________________ AREA CODE FAX ADDRESS _______________________________________________ _______________________________________________________ EMAIL CITY STATE ZIP Section B ____________________________________________________________ ______________ Site Data STREET ADDRESS (INCLUDE ANY A/K/A) ZIP CODE _________________________________________________________________________________________________________ DESCRIPTION OF PROPERTY BY BOUNDING OR CROSS STREETS _______ BLOCK __________ LOT(S) ____________________ BOROUGH _________________________ ___________________________ COMMUNITY DISTRICT NO LANDMARK/ HISTORIC DISTRICT . ____________________________________ _______________________________ ZONING DISTRICT ZONING MAP NUMBER (include special zoning district, if any) __________________________ CITY COUNCILMEMBER Section C Application Description APPLICATION IS HEREBY MADE UNDER: (Consult §11-331 or §11-332 for appropriate entry) 1. Section ZR §11-331 to extend the time of construction for a development for a period of six months: Major development 2. Minor development Section ZR §11-332 to extend the time of construction and/or obtain Certificate of Occupancy for a period of months/ years: Major development Section D Permit Information Minor development Other construction PERMITS (Attachment Item 4) 1. Effective Date of Zoning Amendment: ___________________________________________________ 2. Work authorized under Permit(s) No(s): ___________________________________________________ 3. Date(s) permit(s) issued: ___________________________________________________ 4. Date of Permit Lapse: ___________________________________________________ 5. Has the Department of Buildings notified the owner that the permit(s) lapsed? 6. Permit(s) issued based on plans filed under: N.B. _____________ No Yes Date ________ Alt. No. _____________ American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Section E Construction Information Answer the portion of this section that is applicable to your application. Use separate 8½" x 11" sheets, marked Attachment “Item 5”, to describe in detail the construction work completed, and attach sheets to each copy of the application form submitted. FOR AN APPLICATION UNDER §11-331 1. Has excavation work been completed? No Yes Date of Completion:_____________________ 2. For a Minor development, substantial construction of the foundation has been completed as of (Minor development includes any Enlargement as defined in §11-31). 3. For a Major development: substantial construction of a foundation has been completed as of ________ FOR AN APPLICATION UNDER §11-332 1. Was permit initially vested under §11-331 by DOB BSA 2. For a Minor development, substantial construction has been/will be completed as of ________________ (Minor development includes any Enlargement as defined in §11-31). 3. 4. Section F Financial Information Financial Information For a Major development, substantial construction has been/will be completed as of ________________ For other construction, substantial construction has been/will be completed as of __________________ Answer the portion of this section that is applicable to your application. Use separate 8½" x 11" sheets, marked Attachment “Item 6”, to describe in detail the construction work completed, and attach sheets to each copy of the application form submitted. FOR AN APPLICATION UNDER §11-331 1. Total cost of foundation construction: $ . 2. The cost of foundation construction completed as of date of permit lapse: $ 3. Irrevocable financial commitments on this work, including payments already made to contractors and others, in the amount of $ . . FOR AN APPLICATION UNDER §11-332 1. Total cost/value of construction: $ 2. Total cost/value of construction completed as of date of permit lapse: $ 3. Irrevocable financial commitments on this work, including payments already made to contractors and others, in the amount of $ Section G . . . I HEREBY AFFIRM THAT BASED ON INFORMATION AND BELIEF, THE ABOVE STATEMENTS AND THE STATEMENTS CONTAINED IN THE PAPERS ARE TRUE. Signature _______________________________________________________ SWORN TO ME THIS _____ DAY OF_______20___ Signature of Applicant, Corporate Officer or Other Authorized Representative __________________________ __________________________ __________________________________________ Print Name Title NOTARY PUBLIC American LegalNet, Inc. www.FormsWorkFlow.com